Most prostate cancer patients who forgo aggressive treatment in favor of what is called “active surveillance” or “watchful waiting” receive inadequate attention and often don't follow up with tests and office visits, a new study suggests.
The findings, by the University of California -Los Angeles, suggests the growing number of men diagnosed with low-risk prostate cancer who avoid surgery or radiation to avoid the debilitating potential side effects may be putting themselves in danger.
The UCLA study found that fewer than 5 percent of men who forgo aggressive treatment are being monitored as closely as they should be, putting them in danger of their cancer progressing or spreading.
The study, published in the journal Cancer, examined the records of 37,687 men with prostate cancer who were followed through 2009. They found that of the 3,656 men diagnosed with prostate cancer who did not undergo aggressive treatment, only 4.5 percent were monitored appropriately.
"This is really an important finding, because before patients and their doctors decide to pursue active surveillance as a management option for prostate cancer, both the physician and patient should agree on a follow-up schedule to closely monitor the cancer," said lead researcher Dr. Karim Chamie.
"What was most surprising was that patients who underwent aggressive treatment for their prostate cancer were more likely to receive routine lab testing and visits with their doctor than those not receiving aggressive treatment. In other words, those likely cured through aggressive treatment were followed more closely than patients whose cancers were left untreated."
Recommended monitoring includes routine tests for prostate-specific antigen, or PSA; office visits for physical examination; and at least one additional prostate biopsy within a two-year period, Dr. Chamie said.
"Many researchers have been advocating for active surveillance for men with low-risk disease," he added. "However, this study suggests that before we advise our patients to pursue active surveillance for their prostate cancers, we should be certain that we are committed to closely monitoring the cancers with a repeat biopsy, PSA testing and physical exams."
The study was funded by the Department of Defense and National Institutes of Health.
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